Lumbar pathologies

Question 1

Intervertebral disc herniation (IVD)

Answer 1

Most common source of compressive radiculopathy

Lumbar roots emerge below the associated vertebrae

Most common: L4-5, L5-S1

Pain with valsalva

Types: protrusion, extrusion, sequestration

Contralateral shift: trunk leans away from side of pain

Ipsilateral shift: trunk leans towards side of pain (worst prognosis, sequestration)

Question 2

Facet joint pain

Answer 2

Correlation factors:
- Older age
- history of LBP
- normal gait
- maximal pain with extension from fully flexed
- absence of leg pain
- absence of muscle spasm
- no pain with valsalva

Injection can manage symptoms

Question 3

SI joint pain

Answer 3

Common in women

Common w/ trauma or hormonal changes

Hurts with sit to stand and rolling in bed

Hyper or hypomobile

Treatment options: exercise, manual therapy, SI belt, injection, fusion

Question 4

Spondylosis

Answer 4

Generic term referring to degenerative changes to IVD, joint, degenerative joint disease, or osteoarthritis

“gray hair of the spine”

Treatment: exercise, NSAIDs, injections, RARELY surgery

Question 5

Spondylolysis

Answer 5

Bone defect in pars interarticularis (vertebral arch)

Scotty dog fracture

Increased lumbar lordosis or hyperextension trauma

Can be asymptomatic